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P262. Demographic characteristic of children with early clinical manifestation of the inflammatory bowel disease

S. Szymanska1, M. Szczepanski1, P. Landowski2, G. Czaja-Bulsa3, E. Jarocka-Cyrta4, B. Korczowski5, E. Krzesiek6, E. Szymanska1, J. Kierkus1, 1The Children Memorial Health Institute, Hepatology and Feeding Disorders, Warsaw, Poland, 2Medical University of Gdansk, Poland, 3Pomeranian Medical University, Poland, 4Medical University of Bialystok, Poland, 5Medical College. University of Rzeszow, Poland, 6Medical University of Wroclaw, Poland

Background

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and Ulcerative colitis (UC) is a chronic condition of the colon and small intestine. The disease is common in young people (children and young adults) yet it is rather rare in children younger than 2 years of age. Therefore, IBD developing during the first years of life (under the age of 5) is called an early-onset IBD (EO-IBD) and it is considered to be a specific entity with a distinct phenotype. However, the available data on that issue are still insufficient. The objective of the study was to determine the characteristics and clinical course of children with early-onset IBD.

Methods

We performed a retrospective database analysis of 47 infants younger than 5 years old diagnosed with IBD. The data on patient's demographics, including age, sex, and age at disease onset have been collected through six pediatric hospitals in Poland. Disease location was established on the basis of a review of all endoscopic, colonoscopic, histopathological, and radiological records. All possible complications were reported as well as treatment and its efficacy. Since the diagnosis was established all patients have been on follow up.

Results

Among 47 children registered in the database, 23 (49%) had a diagnosis of CD, 16 (34%) had UC, and 8 (17%) had IC. The mean age at diagnosis was 28.5±27.5 months; 57.4% were male. 17 (36.2%) of patients had proctitis (L2); 8 (17%) – ileocolonic disease (L3), and 20 (42.5%) – left-sided colitis whether CD, UC, or IC. 1 UC patient (2.15%) had affected only the upper gastrointestinal  (GI) tract (L4), and 1 UC patient (2.15%) presented with extra-intestinal symptoms (the diagnosis was established through histopatological examination of the biopsy taken during endoscopy done as a part of diagnostic process). The most common complication of IBD was anemia found in 30 (63.8%) children. The observed course of the disease was either severe or moderate. In 4 children younger than 2 years surgery was performed.

Conclusion

IBD in children younger than 5 years old includes UC, CD, and a relatively high proportion of IC. In early onset IBD severe and moderate course of a disease is usually observed. Disease manifestation in these patients is predominantly colonic (both proctitis and left-sided colitis).